Herb and supplement use in the US adult population

Use of complementary and alternative medicine in patients with chronic liver diseases in Germany- a multicentric observational study

BACKGROUND

The use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany.

METHODS

This is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the "Big five" model, "Hospital Anxiety and Depression"-, "Multidimensional Health Locus of Control"- score). Uni- and multivariate analyses assessed factors associated to CAM use.

RESULTS

Overall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use.

CONCLUSIONS

CAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur.

Investigation of the knowledge, attitudes, and perceptions regarding the utilization of rosemary among the population in Jordan

BACKGROUND

Rosemary (Rosmarinus officinalis) has a rich historical use for various reasons due to its beneficial characteristics including stimulating hair growth, providing antioxidant and antibacterial effects, and functioning as a skin conditioner and fragrance enhancer. The plant is cultivated in Jordan and using it is gaining popularity among the population.

AIM OF THE STUDY

To assess the knowledge, attitude and perception of rosemary use among Jordanians.

MATERIALS AND METHODS

A cross-sectional study was conducted targeting at least 385 participants via social media platforms. Face and content validity of the questionnaire was performed by independent researchers. The questionnaire was divided into three main sections including the demographics section, the knowledge section and the attitude toward rosemary use. Statistical analysis was conducted using SPSS including descriptive statistics, chi-square tests, and multiple linear regression.

RESULTS

The study's participants (n = 407) had a mean age of 30.98 years old (SD = 12.76). The mean knowledge score for the participants ranged from -5 to 7, with a mean of 2.96 (SD = 2.61), with younger participants exhibiting higher knowledge scores regarding rosemary. Approximately half of the participants (48.2%) reported using rosemary for medical purposes. About three-quarters reported using rosemary oil, but a higher percentage reported using the leaves. Around three quarters administered it orally or applied it topically. Most participants obtained rosemary by growing it at home or from herbalists. Family and friends were the main influencers for rosemary users. Most of the study participants strongly agreed/agreed that plants possess a healing power (94.4%). The most reported reason for using rosemary was improving the hair condition (82.1%) followed by gastrointestinal problems (67.9%).

CONCLUSIONS

The study highlights the widespread use of rosemary for different reasons through different methods of application. Addressing misconceptions and enhancing knowledge dissemination may allow informed decision-making and promote the safe and effective use of herbal therapies.

Identification of a Novel Chitinase from Bacillus paralicheniformis: Gene Mining, Sequence Analysis, and Enzymatic Characterization

In this study, a novel strain for degrading chitin was identified as Bacillus paralicheniformis HL37, and the key chitinase CH1 was firstly mined through recombinant expression in Bacillus amyloliquefaciens HZ12. Subsequently, the sequence composition and catalytic mechanism of CH1 protein were analyzed. The molecular docking indicated that the triplet of Asp526, Asp528, and Glu530 was a catalytic active center. The enzymatic properties analysis revealed that the optimal reaction temperature and pH was 65 °C and 6.0, respectively. Especially, the chitinase activity showed no significant change below 55 °C and it could maintain over 60% activity after exposure to 85 °C for 30 min. Moreover, the optimal host strain and signal peptide were obtained to enhance the expression of chitinase CH1 significantly. As far as we know, it was the first time finding the highly efficient chitin-degrading enzymes in B. paralicheniformis, and detailed explanations were provided on the catalytic mechanism and enzymatic properties on CH1.

Current use of medicinal plants for children's diseases among mothers in Southern Romania

There is a limited number of studies focusing on ethnomedical practices in children, particularly in Eastern Europe. Romania has a rich history of using medicinal plants in ethnopediatric care, and our objective was to identify the medicinal plants currently employed in treating childhood illnesses in the southern region of the country. Material and methods Our investigation used structured interviews, focusing on respondent demographics, local names of therapeutically employed herbs, the specific plant part(s) utilized, methods of preparation and administration, and local folk indications of taxa. A total of 326 mothers with children aged 0 to 18, hospitalized in the "Grigore Alexandrescu" Children Emergency Hospital Bucharest and residing in Southern Romania, were enrolled in the study. Use Value Citation Index (UVc), Informant Consensus Factor (Fic), and Fidelity Level (FL) were calculated. Results Twenty-five plants were identified for treating children's diseases in Southern Romania. The majority of informants resided in urban areas, and mothers primarily acquired knowledge from family members and healthcare professionals. The herbs most frequently employed were Mentha spp. (UV = 0.509) for diarrhea, Matricaria spp. (UV = 0.301) for skin infections (Fic = 0.99) and digestive diseases (Fic = 0.98), and Calendula officinalis L. (UV = 0.365) for skin diseases (Fic = 0.99). Less utilized were Raphanus raphanistrum subsp. sativus (L.) Domin in respiratory diseases, Prunus avium (L.) L. stalks in urinary tract ailments, Helianthus annuus L. in ear infections, Allium sativum L. in intestinal parasitosis, Viola tricolor L. in hives, Triticum aestivum L. in dermatitis and Allium ursinum L. as a tonic. In 184 cases herbal treatment was used in conjunction with conventional medications. Education level correlated with the number of employed plants and the variety of treated ailments, while residency (rural vs. urban) did not. Both residency and education influenced plant procurement methods: rural background and, surprisingly, higher education were linked to a preference for harvesting rather than purchasing plants. Conclusion Botanical remedies are still commonly used in the treatment of pediatric diseases in Southern Romania, although the variety of taxa seems reduced compared to the past. Further exploration is essential to unlock the maximum benefits of ethnopediatric practices.

Type and Frequency in Use of Nutraceutical and Micronutrient Supplementation for the Management of Polycystic Ovary Syndrome: A Systematic Scoping Review

Lifestyle strategies are considered first-line treatment for the management of polycystic ovary syndrome (PCOS). However, complementary therapies, including nutrient supplementation, have been identified as a potential adjunct therapy. Therefore, we systematically mapped the available literature to identify the type and frequency of the use of nutraceutical and micronutrient supplementation for the management of PCOS features. A systematic search of the literature was conducted using CINAHL, Cochrane reviews, Medline, PsycINFO, Scopus and LILACS. All types of study designs were included if they reported on the use of nutraceuticals and/or micronutrient supplementation on features of PCOS in women aged ≥18 years. A total of 344 articles were included. Forty-one supplements were identified, with the most frequently investigated being inositols (n = 86), vitamin D (n = 53), N-acetylcysteine (n = 27) and omega-3 fatty acids (n = 25). Reproductive outcomes were the most commonly reported (n = 285; 83%), followed by metabolic (n = 229; 67%), anthropometric (n = 197; 57%) and psychological (n = 8; 2%). Our results identified that nutraceutical and micronutrient supplementation require further investigation of psychological outcomes in women with PCOS. Moreover, adequately powered primary studies are warranted to investigate therapeutic doses needed for clinical benefits.

Safety Concerns Related to the Simultaneous Use of Prescription or Over-the-Counter Medications and Herbal Medicinal Products: Survey Results among Latvian Citizens

The use of herbal medicines is increasing worldwide. While the safety profile of many herbal medicines is promising, the data in the literature show important interactions with conventional drugs that can expose individual patients to high risk. The aim of this study was to investigate the experience of the use of herbal medicines and preparations and the risks of interactions between herbal and conventional medicines among Latvian citizens. Data were collected between 2019 and 2021 using a structured questionnaire designed for pharmacy customers in Latvia. Electronic databases such as Drugs.com, Medscape, and European Union herbal monographs were reviewed for the risk of drug interactions and potential side effects when herbal medicines were involved. The survey included 504 respondents. Of all the participants, 77.8% used herbal preparations. Most of the participants interviewed used herbal remedies based on the recommendation of the pharmacist or their own initiative. A total of 38.3% found the use of herbal remedies safe and harmless, while 57.3% of respondents regarded the combination of herbal and regular drugs as unsafe. The identified herbal medicines implicated in the potential risk of serious interactions were grapefruit, St. John's wort, and valerian. As the risks of herb-drug interactions were identified among the respondents, in the future, both pharmacy customers and healthcare specialists should pay more attention to possible herb-drug interactions of over-the-counter and prescription medications.

Determinants of supplementation among Canadian university students: a theory of planned behavior perspective

OBJECTIVE

The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB).

METHODS

A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants' attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions.

RESULTS

Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention.

CONCLUSIONS

This study confirms the utility of the TPB in predicting university students' supplementation habits.

Herbal medicines for the treatment of cardiovascular diseases: Benefits and risks- A narrative review

Herbal medicines (HMs) have been traditionally used for the prophylaxis/treatment of cardiovascular diseases (CVDs). Their use is steadily increasing and many patients with CVDs often combine HMs with prescribed cardiovascular medications. Interestingly, up to 70% of patients do not notify cardiologists/physicians the use of HMs and up to 90% of cardiologists/physicians may not routinely inquire them about the use of HMs. There is limited scientific evidence from well-designed clinical trials supporting the efficacy and safety of HMs and because they do not reduce morbidity and mortality are not recommended in clinical guidelines for the prophylaxis/treatment of CVDs. There is also a great deal of confusion about the identification, active constituents and mechanisms of action of HMs; the lack of standardization and quality control (contaminations, adulterations) represent other sources of concern. Furthermore, the widespread perception that unlike prescription drugs HMs are safe is misleading and some HMs can cause clinically relevant adverse events and interactions, particularly when used with narrow therapeutic index prescribed cardiovascular drugs (antiarrhythmics, antithrombotics, digoxin). Cardiologists/physicians can no longer ignore the problem. They must improve their knowledge about the HMs their patients consume to provide the best advice and prevent adverse reactions and drug interactions. This narrative review addresses the putative mechanisms of action, suggested clinical uses and safety of most commonly used HMs, the pivotal role of cardiologists/physicians to protect consumers and the main challenges and gaps in evidence related to the use of HMs in the prophylaxis and treatment of CVDs.

Complementary and Alternative Medicines in Northern Cyprus: Public Awareness, Patterns of Use, and Attitudes

Background: The utilization of herbal medicine (HM) as a component of complementary and alternative medicine (CAM) is increasing worldwide. Little is known about justifications for its use and the factors associated with it. This study gains insights into the use of herbal medicines in Northern Cyprus, concentrating on targets for its use, the role played by disease type, reasons for its use, and sources of information. Methods: A questionnaire was utilized to achieve the aim of the study. The questionnaire was distributed to a random sample comprised of people in two different regions in Northern Cyprus over a 12-week period from August to November 2020. A self-administered questionnaire was used for data collection. Moreover, qualitative research explored individuals’ decision making regarding CAM, which aimed to examine 20 patients as a context for beliefs, decision making, and dialogue about CAM. After audio-taping and verbatim transcription, the data were analyzed with qualitative content analysis. Results: The findings show that the majority of respondents learned about herbal products (HPs) and CAM from other patients, the Internet, friends, and family. The results indicate that almost half of the respondents were aware of how CAMs, especially herbal preparations, are used to treat common illnesses. Fennel, ginger, and echinacea were the most commonly used HMs, mainly for the treatment of the common cold. Furthermore, nearly 50% of the participants expressed the belief that HMs are safe, have fewer side effects than conventional medicines, and are also effective for treating minor health conditions. The prevalence was strongly associated with education level based on a Pearson Chi-square analysis. Conclusions: Although herbal medicines were mostly used to treat mild to moderate ailments and the participants were aware of their limitations, the combination of self-medication, inexperienced counseling, and lack of awareness of the risks of herbal medicines is potentially harmful. This is particularly important for elderly users, because although they seemed to be more aware of health-related issues, they generally used more medication than younger people. Given our finding that dissatisfaction with modern medicine is the most important reason for the preferred use of herbal medicines, government agencies, physicians, and pharmaceutical companies should be aware of this issue and should aim to create some level of awareness among users.

Public knowledge, attitudes, and practices towards herbal medicines; a cross-sectional study in Western Saudi Arabia

BACKGROUND

Herbal medicines, derived from medicinal plants, are among the most popular alternative remedies around the globe. In Saudi Arabia, herbal medicines are extensively used by public as part of the culture as well as religious norms. Therefore, this study aimed to evaluate knowledge, attitudes, and practices regarding herbal medicines among the general population in Saudi Arabia.

METHODS

A descriptive cross-sectional survey study was conducted on the general population of Jeddah city with the help of a validated and self-administered questionnaire. Sample size was calculated to be 450 with subjects between 20 and 60 years of either gender. Descriptive and inferential statistical analysis was performed using SPSS.

RESULTS

Results of our data showed that 173 (42.2%) of the total participants used herbal medicines, however, significant association was found between female gender and the usage of herbal medicines (p < 0.001). Approximately, more than half (56.0%) of the respondents agreed that herbal medicines could be used to promote health and treat illnesses, and 45% respondents agreed that herbal medicines are safe. 153 (37.4%) of the participants opined that herbal medicines could be taken with conventional or allopathic medicine. The data also showed a significant (p < 0.05) association between knowledge about the source of herbal medicine and gender where females were found to have more knowledge compared to males. Moreover, a significantly higher number of chronic disease patients were using herbal medicines compared to individuals with no medical problems (p < 0.001). Strikingly, majority (n = 204; 49.9%) of the respondents used herbal medicines as a first choice when sick, while a good number (n = 172; 42.1%) of respondents did not consult doctors before taking herbal medicines.

CONCLUSION

The use of herbal medicines is common among the general population of Jeddah. Although most of the participants believed that the herbal medicines are safe and do not require consultation, there is a dire need to increase awareness as well as to establish effective strategies to evaluate the safety, efficacy and quality of the herbal medicines for propitious consequences of this commonly used entity in the local society.

Dietary Supplement Intake is Associated with Healthier Lifestyle Behaviors in College Students Attending a Regional University in the Southeast: A Cross-Sectional Study

The relationship between intake of dietary supplements and biomarkers such as insulin and insulin-like growth factor has not been well explored. The primary aim of this cross-sectional study was to investigate the associations between supplement intake and biological and lifestyle factors. We hypothesized that dietary supplement intake was associated with healthier lifestyle behaviors. College students attending a Southeast university were recruited between January 2018 and April 2019. Blood samples were collected to measure insulin, insulin-like growth factor 1 (IGF-1) and alanine aminotransferase (ALT). Statistical tests employed were linear regression and analysis of variance. Ninety-eight participants completed the study and 91% reported taking at least one supplement, while 5.1% reported taking 9+ supplements once per week. There were no differences in levels of insulin, IGF-1 and ALT by levels of dietary supplement intake. Although there were no differences in HEI-2015 score among the groups, those who consumed five or more supplements met a higher percentage of the recommended intake for fruits, performed aerobic exercise for longer duration, and had lower body fat percentage compared to participants who consumed two or less supplements at least once per week. These findings are consistent with previous studies and suggest that dietary supplement intake is highly prevalent in college students, and it may be related to healthy lifestyle behaviors. Future studies should employ mixed methodology to examine reasons by which college students consume dietary supplements and to assess perceived and direct health benefits associated with consumption.

Reasons Office-Based Physicians in the United States Recommend Common Complementary Health Approaches to Patients: An Exploratory Study Using a National Survey

Objective: To examine the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Design: Descriptive estimates of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). Setting/Location: The United States. Outcome measures: Reasons for the recommendation or lack thereof to patients for: herbs and other non-vitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation). Differences by physician sex and medical specialty were described. Results: For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]). For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]). Conclusions: There are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians' decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

Chemical Profiling and In Vitro Antiurolithiatic Activity of Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi Along with Its Antioxidant and Antibacterial Properties

Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi (Fabaceae) is an important medicinal plant used to treat various ailments. In this study, we report the antiurolithiatic, antioxidant, and antibacterial potential of chloroform fraction (CF) from P. gangeticus roots. For the chemical profiling, HPTLC, FT-IR, and GC-MS techniques of the CF were carried out, and phytochemical investigation was revealed that stigmasterol (45.06%) is one of the major components present in the fraction. The nucleation and aggregation assays were used to evaluate the in vitro antiurolithiatic activity at various concentration (2-10 mg/mL) of the CF. The results showed that the chloroform fraction had dose-dependent effects on Calcium Oxalate (CaOx) crystal formation. In both the assays, the maximum concentration of 10 mg/mL has shown better results. This concentration resulted significant increase in CaOx crystal nucleation along with the reduction of crystal size and the inhibition of crystal aggregation. Further, the CF showed stronger antioxidant (DPPH, NO, SOD, TRC) potential with an IC₅₀ values of 415.9327, 391.729, 275.971, and 419.14 µg/mL, respectively. The antibacterial evaluation displayed effective results in the Agar well diffusion assay against selective urinary tract infection (UTI) pathogens (Escherichia coli, Klebsiella pneumonia, and Staphylococcus aureus). A maximum zone of inhibition (ZOI) 12.33 ± 1.05 mm for K pneumonia and minimum ZOI of 8.46 ± 0.27 mm for S. aureus were obtained. Further, the ADME-PK property of the stigmasterol was investigated, and it was found to pass the Lipinski and Ghose rules, supporting the drug-likeliness. This is the first record of the antiurolithiatic potential of P. gangeticus along with antioxidant and antibacterial activities. These findings give an insight into the effective drug development and treatment for kidney stones in future.

Exploration of genomic and functional features of chitinolytic bacterium Streptomyces chilikensis RC1830, isolated from Chilika Lake, India

Streptomyces chilikensis RC1830 was previously isolated as a novel chitinolytic streptomycete from Chilika Lake, Odisha, India. The strain RC1830 is a representative member of the soil-dwelling, filamentous Streptomyces group that produces the majority of natural antibiotics and secondary metabolites. The objective of this work was to assess the chitin degradation ability and whole-genome sequence of Streptomyces chilikensis RC1830. TLC analysis of the fermentation product revealed that strain RC1830 can convert shrimp shell colloidal chitin to N-acetylated chitooligosaccharides (N-AcCOS). A genome-wide investigation of RC1830 was also carried out to investigate the genetic basis for chitin breakdown. The result showed that the RC1830 genome possesses a chromosome with 7,121,774 bp (73.2% GC). The genome consists of 6807 coding sequences, 69 tRNA, and 3 rRNA genes. Furthermore, carbohydrate-active enzyme (CAZyme) analysis revealed that RC1830 has 89 glycoside hydrolase family genes, which could modulate the enzymes involved in the degradation of chitin ultimately producing industrially important COS. The whole-genome information of RC1830 could emphasize the mechanism involved in the RC1830's chitin breakdown activity, endowing RC1830 with a promising alternative for COS production.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-022-03184-5.

The use of dietary supplements for mental health among the Saudi population: A cross-sectional survey

Introduction

Methods

Results

Conclusion

A Preliminary Assessment of Tinospora sinensis on Mice Liver

Objective A preliminary study was conducted to assess the role of Tinospora sinensis extract on liver in mice in normal and lipopolysaccharide (LPS)-induced health-compromised conditions.

Method Mice (n = 3–5) were randomly assigned into groups I to IV for hepatotoxic studies. Group I was assigned normal, group II was given LPS (6 mg/kg, intraperitoneal [ip]), group III was given T. sinensis only (1 g/kg/day for 21 days), whereas group IV was administered T. sinensis (1 g/kg/day per os [po] for 21 days) with LPS (6 mg/kg ip given on 7th day). Group V received monocrotaline (MCT) (200 mg/kg, p.o.) only. Group VI received MCT (200 mg/kg, po) and LPS (6 mg/kg ip). Group VII was given T. sinensis (500 mg/kg/day po for 7 days) followed by MCT (200 mg/kg, p.o.) and LPS (6 mg/kg, ip) on the 7th day. Groups V to VII were used to assess the effect of T. sinensis in MCT + LPS-induced hepatotoxicity model.

Results No elevation in alanine transaminase (ALT) levels was observed in mice treated with T. sinensis in group III or group IV compared with normal (vehicle treated) group (group I). Elevation in ALT levels was observed in group VI (MCT + LPS) and group VII; histopathology showed liver injury. Pretreatment of mice with T. sinensis (group VII) did not show any reduction in the elevated ALT levels.

Conclusions In the preliminary assessment, T. sinensis extract was found to exhibit neither hepatotoxicity itself nor the potential to thwart liver damage by a xenobiotic under the given test conditions, dosage, and duration of the study.

Liver Transplantation for Acute Liver Injury in Asians Is More Likely Due to Herbal and Dietary Supplements

Drug-induced liver injury (DILI) due to medications and herbal and dietary supplements (HDSs) is a major cause of acute liver injury leading to liver transplantation (LT). This study used United Network for Organ Sharing LT data to analyze severe HDS-induced acute liver injury in the United States. By convention, patients with acute DILI are listed as "Acute Hepatic Necrosis" (AHN) under the subheading "AHN: Drug Other Specify." All patients waitlisted from 1994 to 2020 were divided into 3 subgroups: "HDS DILI," "Non-HDS DILI," and "AHN: unknown drug." Analyses were performed to identify epidemiologic differences between patients with HDS DILI and non-HDS DILI. A subanalysis was performed for transplanted patients, including longitudinal changes. Of 1875 patients waitlisted for LT, 736 (39.2%) underwent LT. The proportion of Asian patients in the HDS DILI group was significantly higher compared with that in the non-HDS DILI group (17.4% versus 3.8%; P < 0.001). Excluding acetaminophen cases, the proportion of Black patients in the HDS DILI versus non-HDS group was significantly lower (8.7% versus 25.3%; P < 0.001). Waitlisted patients with HDS DILI were significantly older (median age, 38 years for HDS DILI versus 31 years for non-HDS DILI; P = 0.03). Lastly, the number of patients requiring LT due to HDS DILI increased significantly over time with more than 70% of cases occurring in the last 10 years (2010-2020) compared with the prior 15 years (1994-2009; Ptrend  = 0.001). Ethnicity may help in identifying the cause of severe acute DILI, a growing problem as more patients experiment with HDS.

Standardization of Berberis aristata DC and Nigella sativa L. Using HPTLC and GCMS and Their Antineoplasia Activity in 7,12-Dimethylbenz[a]anthracene-Induced Mouse Models

Berberis aristata DC and Nigella sativa L. are officially listed in various Indian Pharmacopoeia and AYUSH official documents. Prescribed for different ailments for proven medicinal activities, they thus became part of polyherbal medications. With reverse pharmacology and scientific validation, more than 30 patents are filed on different formulations of B. aristata and granted. Nigella sativa L. has been broadly studied for its therapeutic potential and wide range of activities against cardiovascular, diabetic, cancer, and life style disorders. Thus, this study is aimed at standardizing B. aristata and N. sativa and their antineoplasia activity in 7, 12-dimethylbenz[a]anthracene (DMBA)-induced mouse models. Molecular docking was done using the Schrodinger program Maestro 9.0. Herbal extracts and essential oil (B. aristata and N. sativa) were standardized and quantified using high-performance thin-layer chromatography (HPTLC) (CAMAG) and gas chromatography–mass spectrometry (GCMS) (Agilent 2010GC System) with validated methods. DMBA was administered orally once a week (1mg/200 µL) to each animal except the normal control. Hematology, histopathology, and immunoassays were performed, and data were analyzed and depicted with GraphPad and SPSS. In molecular docking, thymoquinone showed the highest docking score (9.519, 9.211, and 9.042, respectively) in the active site pockets of IL6 (PDB ID: 4CNI and 5FCU), TNF (PDB ID: 2AZ5), and VEGF (PDB ID: 4KZN). Out of all four target sites, thymoquinone and berberine showed good binding affinity with IL6 (PDB ID: 4CNI) compared to α- and β-pinenes. HPTLC analysis of the hydroalcoholic extract showed the presence of berberine both qualitatively and quantitatively (5.4% berberine), and thymoquinone detected 0.17% in the N. sativa extract. GCMS for essential oil showed 26 compounds including ±pinene. Leukocytes and erythrocytes of N. sativa and B. aristata were analyzed, and significant improvements were recorded (P < 0.05) and graphically presented. Mean survival time was calculated by the Kaplan Meier method (119 days). Immunoassay analyses were conducted, namely, TNF-α and VEGF, and interpreted and marked.

Herbal and dietary supplement induced liver injury: Highlights from the recent literature

Herbal-induced liver injury (HILI) is an important and increasingly concerning cause of liver toxicity, and this study presents recent updates to the literature. An extensive literature review was conducted encompassing September 2019 through March 2021. Studies with clinically significant findings were analyzed and included in this review. We emphasized those studies that provided a causality assessment methodology, such as Roussel Uclaf Causality Assessment Method scores. Our review includes reports of individual herbals, including Garcinia cambogia, green tea extract, kratom as well as classes such as performance enhancing supplements, Traditional Chinese medicine, Ayurvedic medicine and herbal contamination. Newly described herbals include ashwagandha, boldo, skyfruit, and 'Thermo gun'. Several studies discussing data from national registries, including the United States Drug-Induced Liver Injury (DILI) Network, Spanish DILI Registry, and Latin American DILI Network were incorporated. There has also been a continued interest in hepatoprotection, with promising use of herbals to counter hepatotoxicity from anti-tubercular medications. We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration. The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.

Analysing Clusters of Consumers Who Use Medicinal and Aromatic Plant Products

The trend towards health and environmental protection has led to an increase in the consumption of medicinal and aromatic plant (MAP) products. The market for MAP products is influenced by consumer behaviour and therefore the aim of this study was to identify consumer segments that use MAP products for phytotherapeutic, cosmetic and personal care purposes according to their perceptions, attitudes and consumption habits and possible correlations between consumption of MAP products and interest in a healthy lifestyle and sustainable behaviour. Data collection was performed by administering a questionnaire to Cluj-Napoca residents. The final sample consisted of two groups of MAP consumers: the first with 231 respondents who use these products for phytotherapeutic purposes, the second group—with 297 respondents who use them as cosmetic and personal care products. The collected data were statistically analysed using the k-means clustering model, resulting in two distinct clusters in both consumer groups: cluster 1, the “Curious”, and Cluster 2, the “Knowledgeable”. For the consumers of the second cluster, consumption was positively correlated with healthcare and environmental protection, while they exhibited a growing interest in environmentally certified MAP products. The results obtained contribute to a better understanding of the MAP products consumption behaviour while tackling the practical implications for stakeholders in the pharmaceutical and cosmetics industry through the development and innovation of products tailored to consumer needs.

Complementary and alternative medicine (CAM) supplements in cancer outpatients: analyses of usage and of interaction risks with cancer treatment

Purpose

The aim of our study was to analyze the use of complementary and alternative medicine (CAM) supplements, identify possible predictors, and analyze and compile potential interactions of CAM supplements with conventional cancer therapy.

Methods

We included outpatient cancer patients treated at a German university hospital in March or April 2020. Information was obtained from questionnaires and patient records. CAM–drug interactions were identified based on literature research for each active ingredient of the supplements consumed by the patients.

Results

37.4% of a total of 115 patients consumed CAM supplements. Potential interactions with conventional cancer treatment were identified in 51.2% of these patients. All types of CAM supplements were revealed to be a potential source for interactions: vitamins, minerals, food and plant extracts, and other processed CAM substances. Younger age (< 62 years) (p = 0.020, φc = 0.229) and duration of individual cancer history of more than 1 year (p = 0.006, φc = 0.264) were associated with increased likelihood of CAM supplement use. A wide range of different CAM supplement interactions were reviewed: effects of antioxidants, cytochrome (CYP) interactions, and specific agonistic or antagonistic effects with cancer treatment.

Conclusion

The interaction risks of conventional cancer therapy with over-the-counter CAM supplements seem to be underestimated. Supplements without medical indication, as well as overdoses, should be avoided, especially in cancer patients. To increase patient safety, physicians should address the risks of interactions in physician–patient communication, document the use of CAM supplements in patient records, and check for interactions.

Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009-2014 National Health and Nutrition Examination Survey

The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28-1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13-1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were "personal choice or influenced by advertisements or word of mouth," "improve health," and "specific health conditions" (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.

A systematic review of possible interactions for herbal medicines and dietary supplements used concomitantly with disease-modifying or symptom-alleviating multiple sclerosis drugs

Multiple Sclerosis (MS) is a demyelinating disease affecting the central nervous system, with no curative medicine available. The use of herbal drugs and dietary supplements is increasing among people with MS (PwMS), raising a need for knowledge about potential interactions between conventional MS medicine and herbal drugs/dietary supplements. This systematic review provides information about the safety of simultaneous use of conventional MS-drugs and herbal drugs frequently used by PwMS. The study included 14 selected disease-modifying treatments and drugs frequently used for symptom-alleviation. A total of 129 published papers found via PubMed and Web of Science were reviewed according to defined inclusion- and exclusion criteria. Findings suggested that daily recommended doses of Panax ginseng and Ginkgo biloba should not be exceeded, and herbal preparations differing from standardized products should be avoided, especially when combined with anticoagulants or substrates of certain cytochrome P450 isoforms. Further studies are required regarding ginseng's ability to increase aspirin bioavailability. Combinations between chronic cannabis use and selective serotonin reuptake inhibitors or non-steroidal antiinflammatory drugs should be carefully monitored, whereas no significant evidence for drug-interactions between conventional MS-drugs and ginger, cranberry, vitamin D, fatty acids, turmeric, probiotics or glucosamine was found.

Ethnobotanical Survey of Medicinal Plants Used to Treat Cardiovascular Disorders in Ghasemloo Valley of Urmia City

AIMS

Many pharmacutical plants belonged to this region are used as the traditional drug by traditional physicians of the Urmia city in order to treat signs of disorders and cardiovescular system diseases.

BACKGROUND

The Ghasemloo valley located in the Urmia city is one of the typical areas in the northwestern Iran and includes many pharmacutical and plant species.

OBJECTIVE

Many pharmacutical plants belonged to this region are used as the traditional drug by traditional physicians of the Urmia city in order to treat signs of disorders and cardiovescular system diseases.

METHOD

Study was performed among 35 grocers in the Urmia city to identify effective and famous pharmacutical plants in treatment of cardiovescular and related diseases. Firstly a complete list of Urmia grocers was prepared from the Food and Drug Administrator of the Urmia University of Medical Sciences. The direct observation and interview alongside collecting herbarium samples of usual and effective indigenous medicinal plants were used to identify disorders and different signs of cardiovascular diseases. Questionnaires included personal information of grocers and they completed indigenous plants list containing information including the plant local name, the used organ, method of use, and the traditional therapeutic effect. Herbarium samples mentioned in the questionnaire were collected from the region and sent to the Jahad-e-Keshavarzi Research Centers and the Agriculture Faculty of Urmia university to determine the genus and species. After identifying and confirming the plant species, data related to the plant and results of cardiovascular research conducted on them were collected and recorded with reference to valid scientific sites. Data were enterred into the Excel 2010 program and then analyzed.

RESULT

60 medicinal plants of 26 families in Urmia were identified as effective in treatment of cardiovascular diseases from interviews and questionnaires; some plants mentioned in this study had known traditional therapeutic effects on cardiovascular disorders in the literature and some were identified with new effects. Results showed that the most therapeutic effects in cardiovascular diseases belonged to families Rosaceae (15%), Fabaceae (13%), Asteraceae (13%), and Apiaceae (10%). The most used organs of plants were the leave (23%) and fruit (19%). Plants were used mainly as infusion (68%) in the traditional method. Most plants of this study were used to treat the blood cholesterol (29%), hypertension (9%), the blood coagulation, prevention of bleeding (9%), and decrease in the abdominal fat (9%).

CONCLUSION

Some herbs introduced in this study have new therapeutic effects introduced for the first time. It is necessary to study therapeutic effects of indigenous plants presented in this research in order to prove studied and mentioned therapeutic effects and to provide study field for researchers in relation to identifying effective substances and studying claimed clinical effects of these plants on different cardiovascular diseases.

Prevalence and Use of Dietary Supplements Among Pharmacy Students in Saudi Arabia

Purpose

Dietary supplements (DSs) are popular in many countries, and their use among individuals is increasing worldwide. Therefore, this study aimed to assess the prevalence and use of DSs among pharmacy students in King Saud University College of Pharmacy, Riyadh, Saudi Arabia.

Methods

This study used a cross-sectional design targeting male senior pharmacy students in their fourth and fifth years of Bachelor and Doctor of Pharmacy courses. The data were collected between August and October 2019 using paper-based questionnaires.

Results

A total of 46.8% of the students used DSs. Of all students surveyed, 19% used branded supplements whereas 9.7% used generic or local supplements and 12.3% used both generic and branded supplements. Furthermore, 8.2% students suffered from side effects, including 5.6% who suffered from nausea, vomiting, and diarrhea and 2.6% who suffered from headache, confusion, and disorientation. Approximately 24.6% of students used fiber DSs whereas 19% and 16.4% used DSs for protein and glucosamine/omega 3 fatty acids, respectively.

Conclusion

The study findings indicated that the prevalence of DS use is increasing. However, approximately half of the respondents encourage the use of DSs only with a doctor’s recommendation. Educating about the safe use of DSs is warranted.

Medicinal plants/herbal supplements as female aphrodisiacs: Does any evidence exist to support their inclusion or potential in the treatment of FSD?

ETHNOPHARMACOLOGICAL RELEVANCE

Female Sexual Dysfunction is a complex condition with biopsychosocial origins. Plants traditionally used as aphrodisiacs may be promising as routes to develop therapeutic options which are lacking.

AIM

To distinguish the plants commonly used in (AP) on the market in the United States, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion.

METHODS

This study is a narrative review of 53 species commonly found in AP on the market in the United States. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders.

RESULTS

There is little to no evidence from the literature to substantiate claims of plants currently on the market as AP for female libido desire disorders.

CONCLUSIONS

The biggest problem in the literature is the lack of botanical verification and consistency in material across studies. Any botanical, commercial or otherwise must be tested for chemical markers exhibited by individual species; however, if no markers exist, work must first be done to determine these. Appropriate analytical techniques for this would include high pressure liquid chromatography, and mass spectroscopy. It would also be sufficient to taxonomically authenticate species provided the plant material. Further research should aim to standardize plant material and extraction methods utilized in order to compare studies effectively and allow for reproducibility to draw conclusions. While clear interest into investigation the aphrodisiac potential of plants exists, a translatable in vivo animal model does not. Clinical trials rely on patient reported outcomes to determine efficacy but cost and length of such trials deem a necessity for development of an animal model to first screen botanicals. We suggest development of screening tools utilizing the evident neurobiological underpinnings of FSD as the first step. In general, studies of plants currently used as ingredients for AP are severely lacking, and even so the evidence that exists is weak.

Natural Health Product-Drug Interaction Causality Assessment in Pediatric Adverse Event Reports Associated with Attention-Deficit/Hyperactivity Disorder Medication

Background: Some pediatric patients with attention-deficit/hyperactivity disorder (ADHD) use natural health products (NHPs) such as herbal remedies. Although herbal remedies are generally considered to be safe when they are used appropriately, they may contain active components that can interact with medications being used concurrently, with potential for NHP-drug interactions leading to adverse events. Objectives: The objectives of this study were (1) to identify adverse event reports (AERs) involving commonly used herbal remedies and ADHD prescription medicines in children and adolescents; (2) to evaluate the quality of collected AERs; and (3) to assess whether NHP-drug interactions can be causally linked to reported adverse events. Methods: We systematically searched the FDAble database (FDAble.com) for herbal remedies commonly used by patients (4-18 years old) also taking ADHD drugs from 1997 to 2015. We assessed the completeness of the AERs and used three causality assessment tools modified for NHPs (Naranjo Adverse Drug Reaction Probability Scale, HORN Drug Interaction Probability Scale, and World Health Organization Uppsala Monitoring Centre Scale). Results: Of the 23 identified AERs involving both an herbal remedy and an ADHD prescription medication, most involved multiple (>3) substances with inadequate detail to assess multiple potential interactions. Following data extraction and evaluation of completeness, five AERs involving only one herbal remedy and one ADHD medication were evaluated for causality. An NHP-drug interaction was assessed to be probable in one case and to be possible in another. Both these reports involved a methylphenidate formulation and St. John's wort. Conclusions: Eighteen of the 23 identified AERs involving both an herbal remedy and an ADHD drug also involved other multiple ingredient products. The reporting quality was poor for the five AERs examined. Further research is needed to study the interaction between St. John's wort and methylphenidate.

Immigrant Usage Patterns of Natural Health Products: Role in Pharmacoeconomics

Background:

Understanding patterns and drivers for natural health product (NHP) usage among immigrants is essential in the provision of appropriate health care; many studies have elucidated NHP utilization among immigrants; however, few have considered impacts of concurrent NHP and prescription medication usage.

Objective:

The study aims to determine new immigrant NHP usage patterns (including concurrent usage with prescription medications) and to discern economic impacts driving concurrent usage.

Methods:

A survey questionnaire was administered to local new immigrants during English Language Training classes.

Results:

Most participants understood the NHP definition and would take an NHP for the same disease or condition they would normally take a prescription medication for. Many participants agreed that NHPs are not safe however were unable to provide robust examples of unsafe NHP usage. With regard to purchases of medicines for short and long term illnesses, a high percentage of participants would purchase the prescription medication for a short term illness over the NHP; however this percentage decreases in the event of a long term illness, with more participants relying on NHPs to remedy their long term illness symptoms.

Conclusion:

Pharmacoeconomics tends to be a major driver for immigrant utilization of NHPs, and is a stronger influencer of use compared to ethnicity or parenteral usage of such products. This pharmacoeconomic correlation in the preference to use NHPs over prescription medications tends to be more observable for chronic and long term conditions (compared to short term illnesses).

The importance of herbal medicine use in the German health-care system: prevalence, usage pattern, and influencing factors

Background

Prevalence rates for herbal medicine (HM) have been increasing worldwide. However, little is known about prevalence, user characteristics, usage pattern and factors influencing HM usage for the general German population.

Methods

A nationwide online survey on HM usage was conducted in Germany. The 2906 participants were categorised into three groups: the ones who used HM in the last 12 months, the ones who did not use HM in the last 12 months but in their lifetime, and the ones who did not use HM until now. Data were analysed by descriptive statistics, Chi Square tests and binary hierarchical logistic regression analyses.

Results

Prevalence rates of HM were found to be very high for the general German population. Self-medication appeared as a common praxis, when at the same time HM users responded that they do not inform their physician about it, rate their knowledge about HM as somewhat poor, and use the internet as the most frequent source of information. The HM user in the last 12 months was found to include people that were more likely female, highly educated, privately insured, employed, and engaged in a more health-oriented lifestyle. While certain sociodemographic- and health-related variables influence HM usage vs. non-usage, they explain variance only to a limited extent. For distinguishing the user in the last 12 months vs. the less recent user who did not use HM in the last 12 months, ratings on different reasons for HM usage were found to perform better as predictors than sociodemographic- and health-related variables.

Conclusions

This study demonstrated that HM usage plays an essential role in the German health-care system. Furthermore, the HM usage pattern may be potentially harmful for patients, as it included self-medication, little knowledge on interaction- and side-effects of HM, and a lack of communication with physicians about the usage. Moreover, prediction of HM usage in the previous year is impacted by variables beyond conventional sociodemographic- and health-related ones. In view of the high prevalence rates of HM in Germany, medical as well as health service providers should be aware of these issues.

Herb-Drug Interactions and Hepatotoxicity

BACKGROUND

In recent times, herbals or phytomedicines have become very popular due to their global acceptance as a complementary and alternative remedy. While modern drugs are commercially available only after laboratory validations, clinical trials, as well as approval from drug regulatory authorities, majority of the marketed herbal products lack such scientific evidence of efficacy and safety. This results in herb or herb-drug interaction induced unfavorable clinical outcomes without crucial documentation on their temporal relations and concomitant use.

METHODS

An online literature search for peer-reviewed articles was conducted on the PubMed, Europe PMC, Medline and Google Scholar portals, using the phrases: complementary & alternative medicine, traditional Chinese medicine, herb-drug interaction, mechanisms of herb-drug interaction, herb-induced toxicity, herbal hepatotoxicity and causality, traditional medicine, viral hepatitis, etc.

Results

The retrieved data showed that globally, patients are attracted to herbal remedies with the misconception that these are completely safe and therefore, use them simultaneously with prescription drugs. Notably, there exists a potential risk of herb-drug interactions leading to some adverse side effects, including hepatotoxicity. The toxicological effect of a drug or herb is due to the inhibition of drug metabolizing enzymes (e.g., cytochrome P450), including interactions with certain prescription drugs through various mechanisms. Several cases of hepatotoxicity due to use of herbals in viral hepatitis-related liver diseases have been recently reported. However, limited experimental data and clinical evidence on herbal pharmacokinetics hamper the evaluation and reporting of adverse reactions and the underlying mechanisms.

CONCLUSION

Herb-drug interaction related morbidity is thus an emerging serious public health issue with broad implications for clinicians, pharmaceutical industries and health authorities. Nonetheless, despite increasing recognition of herb-drug interaction, a standard system for interaction prediction and evaluation is still nonexistent. This review article discusses the herb-drug interactions related hepatotoxicity and underlying mechanisms, including drug metabolizing enzymes and their regulation.

Associations of Herbs and Nonvitamin Dietary Supplements Use with Clinical Outcomes Among Adult and Pediatric Patients with Asthma in the United States

BACKGROUND

Herbs and nonvitamin dietary supplements (NVDS) have been commonly used among patients with asthma, yet evidence of their impact on patients' clinical outcomes is limited.

OBJECTIVE

This study examined the associations of herbs and NVDS use with asthma episodes and asthma-related emergency department (ED) visits among US adults and pediatric patients with asthma.

METHODS

A cross-sectional analysis of the 2012 National Health Interview Survey data included 2,930 US adults and 1923 children with self-reported asthma. We estimated the prevalence and type of herbs and/or NVDS use and identified factors associated with their use. We then used multivariable logistic regression models to examine the associations between these supplemental medications use and asthma outcomes, controlling for patient-related covariates. All results were weighted to represent national estimates.

RESULTS

Approximately 7.20% of American children and 21.17% of adults with asthma used herbs and/or NVDS in 2012. Herb and/or NVDS users were more likely to be female, non-Hispanic white, living in the West region, having higher family income, and having comorbidities compared with nonusers. Herbs and/or NVDS use was associated with lower likelihood of having asthma-related ED visit (adjusted odds ratio = 0.48; 95% confidence interval: 0.31, 0.75) among adult patients with asthma, but not for pediatric patients with asthma. No association between herbs and/or NVDS use and having an asthma episode was observed in either adults or children.

CONCLUSIONS

This study found high prevalence of herbs and/or NVDS use among US patients with asthma. Potential benefit of these supplemental medications use on asthma-related ED visits might exist for adult patients with asthma.

Critical evaluation of a putative glucosamine excretion by Aspergillus niger CBS120.49 and Penicillium ochrochloron CBS123.824 under citric acid producing conditions

As one of the most frequently occurring monomers in the biosphere, glucosamine is a valuable metabolite for several applications. Although microbial glucosamine production is still in its infancy, it offers the possibility to circumvent problems associated with traditional production by hydrolysis. Of particular interest is a study with Aspergillus niger, which reports for the first time high glucosamine excretion in the early phase of citric acid production. These results have relevance for both the commercial glucosamine production and deeper insight into the regulation of organic acid excretion in fungi. To investigate glucosamine excretion, we performed bioreactor batch cultivations with Penicillium ochrochloron CBS123.824 and A. niger CBS120.49 using cultivation conditions which are known to trigger the production of citric acid. Glucosamine detection in culture filtrates was achieved by two photometric methods, High performance liquid chromatography with evaporative light scattering detection (HPLC-ELSD) and HPLC with mass spectrometry detection (HPLC-MS). Surprisingly, we detected no glucosamine at all. Based on a critical review of published data for A. niger, we conclude that the reported high levels of excreted glucosamine might be an experimental artifact. However, growth experiments with glucosamine as a combined or single source for carbon or nitrogen showed that both organisms are in principle able to transport glucosamine across their plasma membrane, which is a prerequisite for the excretion of glucosamine.

Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women

Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Development of effective treatment strategies for stimulant use disorders identified among pregnant women are urgently needed.

Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis

Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.

Safety Evaluation of a New Traditional Chinese Medical Formula, Ciji-Hua'ai-Baosheng II Formula, in Adult Rodent Models

Background

Ciji-Hua'ai-Baosheng II Formula (CHB-II-F) is a new traditional Chinese medical formula that has been shown to reduce toxicity and side effects of chemotherapy and increase the probability of cancer patient survival. Whether CHB-II-F is safe as an adjunctive therapy for cancer patients receiving chemotherapy has yet to be determined.

Purpose

To evaluate the acute and subchronic toxic effects of CHB-II-F in rodent models.

Methods

In acute toxicity test, 24 Kunming mice were divided into 2 groups: untreated control and CHB-II-F 1.05 g/mL (31.44 g/kg) treated group. Treatment was administered to the treated group 3 times a day for 14 days. The overall health, adverse reactions, and mortality rate were documented. In subchronic toxicity test, 96 Sprague-Dawley rats were divided into 4 groups: untreated control, high dose CHB-II-F (H) (26.20 g/kg), medium dose CHB-II-F (M) (13. 10 g/kg), and low dose CHB-II-F (L) (6.55 g/kg) [equal to 24.375 g (dried medicinal herb)/kg] treated groups. Treated groups were given the treatments once a day for 4 weeks. The overall health and mortality rate were recorded every day. Body weight and food consumption were measured once a week. Hematologic and biochemical parameters, organ weights, and histopathologic markers were analyzed after 4 weeks. An additional 2 weeks were given as the treatment recovery period before end-point euthanization, and biochemical analyses were performed.

Results

The maximum tolerated dose (MTD) of CHB-II-F on mice was found to be 94.31 g/kg [equal to 351 g (dried medicinal herb)/kg], which is 108 times the human adult dose. In the acute toxicity test, administration of CHB-II-F 31.44 g/kg showed no adverse effect and did not cause mortality. In the subchronic toxicity test, after 4 weeks of treatment, compared to the controls, total cholesterol (TCHO) level, cardiac and splenic indexes, body weights of female rats, and mean corpuscular hemoglobin concentration (MCHC) in the CHB-II-F (H) group were significantly increased; triglyceride (TG) in the CHB-II-F (M) group and liver and splenic indexes in the CHB-II-F (L) group were increased. After the two-week recovery period, biofluid analyses, food consumption, and histopathologic examinations showed no abnormalities.

Conclusion

Administration of CHB-II-F had no obvious adverse effect on the overall health of rodent models. A daily maximum dose of less than 94.31 g/kg or 6.55 g/kg CHB-II-F for 4 continuous weeks was considered safe.

Applying an Ethical Framework to Herbal Medicine

Herbal medicines make a vital contribution to healthcare globally, but from production through to practice, there are ethical challenges that require attention. Ethical challenges are often analysed through application of an ethical framework because this can facilitate a consistent and structured approach. In healthcare, the most commonly used framework over recent decades has been that of the four principles: beneficence, nonmaleficence, autonomy, and justice. However, for various reasons that are explained, this approach to ethical analysis is not the most fitting for the global phenomenon of herbal medicine. In this paper, a relatively new moral framework that is based upon the globally accepted values of care, respect, honesty, and fairness is explored in relation to herbal medicine for the first time. Through application of this framework, the ethical challenges and actions needed to address them become clear, thus resulting in practical recommendations for enhancing ethical standards in herbal medicine.

Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review

Herbal weight-loss supplements are sold as self-medication products, and are often used under the misconception that their natural origin guarantees their safety. Food supplements are not required to provide any benefit/risk profile evaluation before marketing; however, possible risks associated with use of herbal extracts in food supplements are becoming more and more documented in the literature. Some herbs are listed as the leading cause of herb-induced liver injury, with a severe or potentially lethal clinical course, and unpredictable herb-drug interactions. Garcinia cambogia (GC) extract and GC-containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we present four cases of acute liver failure in women taking GC extract for weight loss, and a literature review of clinical evidences about hepatic toxicity in patients taking dietary supplements containing GC extract.

The Prevalence of Dietary Supplement Use Among Elementary, Junior High, and High School Students: A Nationwide Survey in Japan

The prevalence of dietary supplement use, such as vitamins, minerals, or fish oil, has increased among children in Japan; however, whether children are using dietary supplements appropriately remains unclear. This study aimed to determine dietary supplement use among children. In August 2017, a nationwide internet preliminary survey of 265,629 mothers aged from 25 to 59 years old was undertaken. Of these, 19,041 mothers of children attending either elementary school, junior high school, or high school were selected. Among them, 16.4% were currently providing their children with dietary supplements and 5.2% had previously given dietary supplements to their children. The prevalence of dietary supplement use was higher in boys than in girls, and the prevalence increased according to their grade. A total of 2439 participants were eligible to undertake a targeted survey on dietary supplement use. Dietary supplements were being taken to maintain health, supplement nutrients, and enhance growth in both boys and girls, and many children (37.5%) were provided with vitamin and mineral supplements. Mothers mainly obtained information concerning dietary supplements via the internet, and supplements were purchased in drug stores or via the internet. The prevalence of dietary supplement use in mothers was 65.4% and may be associated with the prevalence rates in children. Some mothers reported adverse events (3.6%) in their children, such as stomachache, diarrhea, nausea and vomiting, and constipation. The cause-and-effect relationships for adverse events were not clear, but some children were given products for adults. Children are more influenced by dietary supplements compared to adults. To prevent adverse events due to inappropriate use, parental education concerning dietary supplements is essential.

Why people use herbal medicine: insights from a focus-group study in Germany

BACKGROUND

The use of herbal medicine, as one element of complementary and alternative medicine, is increasing worldwide. Little is known about the reasons for and factors associated with its use. This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information.

METHODS

Using a qualitative methodological approach, six focus groups (n = 46) were conducted. Two groups with young, middle-aged and elderly participants, respectively. After audiotaping and verbatim transcription, the data were analysed with a qualitative content analysis.

RESULTS

We found that treating illnesses was the most frequently discussed aim for using herbal medicine over all age groups. Preventing illnesses and promoting health were less frequently mentioned overall, but were important for elderly people. Discussions on herbal medicine were associated with either mild/moderate diseases or using herbal medicine as a starting treatment before applying conventional medicine. In this context, participants emphasized the limits of herbal medicine for severe illnesses. Dissatisfaction with conventional treatment, past good experiences, positive aspects associated with herbal medicine, as well as family traditions were the most commonly-mentioned reasons why herbal medicine was preferred as treatment. Concerning information sources, independent reading and family traditions were found to be equally or even more important than consulting medicinal experts.

CONCLUSIONS

Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue.

Why people use herbal medicine: insights from a focus-group study in Germany

BACKGROUND

The use of herbal medicine, as one element of complementary and alternative medicine, is increasing worldwide. Little is known about the reasons for and factors associated with its use. This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information.

METHODS

Using a qualitative methodological approach, six focus groups (n = 46) were conducted. Two groups with young, middle-aged and elderly participants, respectively. After audiotaping and verbatim transcription, the data were analysed with a qualitative content analysis.

RESULTS

We found that treating illnesses was the most frequently discussed aim for using herbal medicine over all age groups. Preventing illnesses and promoting health were less frequently mentioned overall, but were important for elderly people. Discussions on herbal medicine were associated with either mild/moderate diseases or using herbal medicine as a starting treatment before applying conventional medicine. In this context, participants emphasized the limits of herbal medicine for severe illnesses. Dissatisfaction with conventional treatment, past good experiences, positive aspects associated with herbal medicine, as well as family traditions were the most commonly-mentioned reasons why herbal medicine was preferred as treatment. Concerning information sources, independent reading and family traditions were found to be equally or even more important than consulting medicinal experts.

CONCLUSIONS

Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue.

Exercise training ameliorates glucosamine-induced insulin resistance in ovariectomized rats

OBJECTIVE

Glucosamine (GlcN), which has been reported to induce insulin resistance (IR), is a popular nutritional supplement used to treat osteoarthritis in menopausal women. We previously demonstrated that GlcN treatment caused IR in ovariectomized rats by reducing the expression of glucose transport protein subtype 4 (GLUT-4) in skeletal muscle. In the present study, we hypothesized that endurance exercise training can reverse GlcN-induced IR.

METHODS

Fifty female rats were randomly divided into five groups with 10 rats in each group: (1) sham-operated group; (2) sham-operated group with GlcN treatment for 14 days; (3) ovariectomy (OVX) group; (4) OVX with GlcN treatment; and (5) OVX with GlcN treatment followed by exercise training (running program) for 8 weeks.

RESULTS

Fasting plasma glucose increased in the OVX + GlcN group, and fasting plasma insulin and the homeostasis model assessment-insulin resistance (HOMA-IR) were significantly higher only in this group. After the rats received exercise training for 8 weeks, no increase in the fasting plasma glucose, insulin, or HOMA-IR was observed. In an intraperitoneal glucose tolerance test, the plasma glucose, plasma insulin, HOMA-IR, and glucose-insulin index were significantly elevated only in the OVX with GlcN treatment group. However, the plasma glucose, plasma insulin, HOMA-IR, and glucose-insulin index decreased after exercise training for 8 weeks, implying that GlcN-induced IR in OVX rats could be reversed through exercise. A histological analysis revealed that exercise training can reduce islet hypertrophy and maintain GLUT-4 in skeletal muscle.

CONCLUSIONS

Exercise training can alleviate IR in OVX rats treated with GlcN. Islet hyperplasia was subsequently prevented. Preserving GLUT-4 expression may be one of the mechanisms by which exercise prevents IR.

Special diets in modern America: Analysis of the 2012 National Health Interview Survey data

BACKGROUND

Special diets are frequently used by the public but reasons for use and characteristics of users remain unclear.

AIM

To determine prevalence of the use of special diets, the individual characteristics associated with their use and reasons for use.

METHODS

The secondary analysis used data from the 2012 National Health Interview Survey (NHIS), a cross-sectional household interview survey of a nationally representative sample of non-hospitalized US adult populations ( n = 34,525). The dependent variables in this secondary analysis were the use of a special diet (vegetarian, macrobiotic, Atkins, Pritikin, and Ornish) ever and during the past 12 months. Independent variables included sociodemographic, clinical and behavioral variables. Prevalence of special diet use and reasons for use were analyzed descriptively. Associations between independent and dependent variables were analyzed using Chi-square tests and logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Lifetime and 12-month prevalence of using special diets were 7.5% (weighted n = 17.7 million) and 2.9% (weighted n = 6.9 million), respectively. Individuals using special diets in the past 12 months were more likely female (OR = 1.45; 95% CI = 1.21-1.74), not married (OR = 0.76; 95% CI = 0.63-0.91), college-educated (OR = 1.98; 95% CI = 1.25-3.11) and depressed (OR = 1.50; 95% CI = 1.14-1.98). They more likely also used herbal products (OR = 2.35; 95%CI = 1.84-2.99), non-vitamin (OR = 1.82; 95% CI = 1.45-2.27) and vitamin supplements (OR = 1.57; 95% CI = 1.24-1.99). Diets were mainly used to improve overall health (76.7%) or for general wellness/prevention (70.4%).

CONCLUSIONS

Special diets are mainly used for unspecific health reasons by those who are females, have a college degree or with depression, and commonly used in conjunction with herbs and dietary supplements.

Abuse and Misuse of Selected Dietary Supplements Among Adolescents: a Look at Poison Center Data

OBJECTIVE

The use of dietary supplements has increased and is associated with adverse effects. Indications for use include recreation, body image concerns, mood enhancement, or control of medical conditions. The risk of adverse effects may be enhanced if agents are used improperly. The objective of this study was to determine the frequency of abuse and misuse of 4 dietary substances among adolescents reported nationally to poison centers. Secondary outcomes included an assessment of medical outcomes, clinical effects, location of treatments provided, and treatments administered.

METHODS

This descriptive retrospective review assessed data concerning the use of garcinia (Garcinia cambogia), guarana (Paullinia cupana), salvia (Salvia divinorum), and St John's wort (Hypericum perforatum) among adolescents reported nationally to poison centers from 2003 to 2014. Adolescents with a singlesubstance exposure to one of the substances of interest coded as intentional abuse or misuse were included. Poison center calls for drug information or those with unrelated clinical effects were excluded. Data were collected from the National Poison Data System.

RESULTS

There were 84 cases: 7 cases of Garcinia cambogia, 28 Paullinia cupana, 23 Salvia divinorum, and 26 Hypericum perforatum. Garcinia cambogia was used more frequently by females (100% versus 0%), and Paullinia cupana and Salvia divinorum were used more frequently by males (61% versus 36% and 91% versus 9%, respectively). Abuse, driven by Salvia divinorum, was more common overall than misuse. Abuse was also more common among males than females (p <0.001). Use of these agents fluctuated over time. Overall, use trended down since 2010, except for Garcinia cambogia use. In 62 cases (73.8%), the medical outcome was minor or had no effect or was judged as nontoxic or minimally toxic. Clinical effects were most common with Paullinia cupana and Salvia divinorum. Treatment sites included emergency department (n = 33; 39.3%), non-healthcare facility (n = 24; 28.6%), admission to a health care facility (n = 8; 9.5%), and other/unknown (n = 19; 22.6%).

CONCLUSIONS

Abuse and misuse of these dietary supplements was uncommon, and outcomes were mild. Further research should be performed to determine use and outcomes of abuse/misuse of other dietary supplements in this population.

The Prevalence of Dietary Supplement Use among College Students: A Nationwide Survey in Japan

To clarify the prevalence of dietary supplement use among college students, we conducted Internet-based nationwide questionnaire surveys with 157,595 Japanese college students aged between 18 to 24 years old who were registrants of Macromill Inc. (Tokyo, Japan). Among the 9066 respondents (response rate 5.8%), 16.8% were currently using dietary supplements. The prevalence of dietary supplement use did not differ significantly between males (17.1%) and females (16.7%). However, it increased according to their grade (13.1% to 20.5%), and it was higher in medical and pharmaceutical college students (22.0%) compared to others (16.7%). The main purpose of dietary supplement use was for the health benefits in both males and females. Other reasons were to build muscle in males, and as a beauty supplement and for weight loss in females. According to the purpose of dietary supplement use, the most commonly-used dietary supplements were vitamin/mineral supplements in both males and females, then protein and weight loss supplements in males and females, respectively. Although most students obtained information about dietary supplements via the Internet, they typically purchased the supplements from drug stores. Of the students surveyed, 7.5% who were currently using or used to use dietary supplements experienced adverse effects, with no significant difference between genders (8.8% in male, 7.0% in female). In conclusion, the prevalence of dietary supplement use increased with grade among college students in Japan. Some of them experienced adverse effects. Education may be important to prevent adverse effects resulting from supplement use in college.

The Use of Herbal Remedies among Mothers of Young Children Living in the Central Appalachian Region

Introduction

Women often use herbal remedies as a complement or alternative to traditional medicine. Guided by the Comprehensive Model of Information Seeking, this study examined use of herbal remedies among mothers of young children living in the Central Appalachian Region.

Methods

A cross-sectional study was conducted among mothers of young children (n = 178). The outcome measure of interest was the use of any herbal remedy in the past six months. Two scales were developed to measure information seeking channels and to measure beliefs about the safety/efficacy of herbal remedies.

Results

One-third reported using herbal remedies in the past six months, with fenugreek being the most common. Most reported using herbal remedies to increase breast milk production and to relieve cold/flu-like symptoms. Women scoring highest in information seeking channels were three times as likely to use herbal remedies. Women scoring highest in the beliefs about the safety/efficacy of herbal remedies were four times as likely to use herbal remedies.

Conclusion

Herbal remedies are commonly used among women living in the Central Appalachian Region, a region with lower education and income level. Therefore, public health interventions about the types, safety, and efficacy of herbal remedies may improve health within this population.

Knowledge and characteristics of herbal supplement usage among community pharmacy customers in a Malaysian population

OBJECTIVES

We investigated the knowledge and characteristics of herbal supplement usage of the customers of community pharmacies in a Malaysian population.

DESIGN AND SETTING

Self-administered questionnaires (in English, Malay, or Chinese) were provided to customers at three community pharmacies in Malaysia (Ipoh, Perak). Questionnaire validation and translation validation were performed. A pilot study was conducted before actual questionnaire distribution. Informed consent was obtained from all participants.

RESULTS

Total number of participants was 270 (99 males and 171 females) with majority from the 31-50 age group (41.5%). Among the participants, 45.6% were herbal users. The most commonly used herbal supplements were evening primrose oil (17.9%), ginkgo biloba (13.0%), and milk thistle (8.5%). The participants seemed to have sufficient knowledge regarding herbal supplements including safety, quality, and indication of use from medical literature. Participants obtained information about herbal supplements from pharmacists (26.9%), package inserts (25.2%), friends (20.5%), and the Internet (13.3%) more often than from their doctors (9.8%). Most herbal users did not inform their doctors about their usage of herbal supplements (68.3%) or the side effects (61.5%). Herbal supplement users also tended to be women, >50-year-old, and those with higher monthly household incomes.

CONCLUSIONS

Community pharmacists have a vital role in educating their customers about the safe use of herbal supplements. The participants had sufficient knowledge about herbal supplement usage; therefore, customers of these community pharmacies may have benefitted from the advice of the pharmacists. Further studies could be carried out in future on the knowledge, skills and roles of community pharmacists in the safe use of herbal supplements.